Healthcare Provider Details

I. General information

NPI: 1013852730
Provider Name (Legal Business Name): DOMINIQUE MERSADIES DEVINE-WOODARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11255 HALL RD STE 102
UTICA MI
48317-5823
US

IV. Provider business mailing address

11255 HALL RD STE 102
UTICA MI
48317-5823
US

V. Phone/Fax

Practice location:
  • Phone: 586-533-4464
  • Fax: 855-631-0679
Mailing address:
  • Phone: 586-533-4464
  • Fax: 855-631-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704415916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: